An Integrative Systematic Review of the Medical Literature on Pain Clinic Definitions and Comparison With Existing State Laws and Regulations

Journal of Substance Abuse Treatment, Prevention, & Policy. 2018. 13(17)

11 Pages Posted: 7 May 2019

See all articles by Barbara Teresa Andraka-Christou

Barbara Teresa Andraka-Christou

Health Management & Informatics, College of Health & Public Affairs, University of Central Florida

Joshua B. Rager

Indiana University - School of Medicine

Brittany Brown-Podgorski

Indiana University

Ross D. Silverman

Indiana University

Dennis P. Watson

Indiana University

Date Written: October 7, 2018

Abstract

BACKGROUND: In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature.

METHODS: We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy.

RESULTS: In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions.

CONCLUSIONS: This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.

Keywords: pain clinic, regulation, definition, pain treatment

Suggested Citation

Andraka-Christou, Barbara Teresa and Rager, Joshua B. and Brown-Podgorski, Brittany and Silverman, Ross D. and Watson, Dennis P., An Integrative Systematic Review of the Medical Literature on Pain Clinic Definitions and Comparison With Existing State Laws and Regulations (October 7, 2018). Journal of Substance Abuse Treatment, Prevention, & Policy. 2018. 13(17). Available at SSRN: https://ssrn.com/abstract=3367896

Barbara Teresa Andraka-Christou (Contact Author)

Health Management & Informatics, College of Health & Public Affairs, University of Central Florida ( email )

4000 Central Florida Blvd
Orlando, FL 32816-1400
United States

Joshua B. Rager

Indiana University - School of Medicine

340 W 10th St #6200
Indianapolis, IN 46202
United States

Brittany Brown-Podgorski

Indiana University

107 S Indiana Ave
100 South Woodlawn
Bloomington, IN 47405
United States

Ross D. Silverman

Indiana University

107 S Indiana Ave
100 South Woodlawn
Bloomington, IN 47405
United States

Dennis P. Watson

Indiana University

107 S Indiana Ave
100 South Woodlawn
Bloomington, IN 47405
United States

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